{"id":1796,"date":"2005-10-01T01:00:00","date_gmt":"2005-10-01T00:00:00","guid":{"rendered":"https:\/\/angh.net\/abstracts\/ponction-pancreatique-sous-echoendoscopie-resultats-et-utilite-dans-la-vraie-vie\/"},"modified":"2018-10-20T18:39:37","modified_gmt":"2018-10-20T16:39:37","slug":"ponction-pancreatique-sous-echoendoscopie-resultats-et-utilite-dans-la-vraie-vie","status":"publish","type":"post","link":"https:\/\/angh.net\/abstracts\/ponction-pancreatique-sous-echoendoscopie-resultats-et-utilite-dans-la-vraie-vie\/","title":{"rendered":"Ponction pancr\u00e9atique sous \u00e9choendoscopie : r\u00e9sultats et utilit\u00e9 dans la vraie vie"},"content":{"rendered":"

2005<\/strong><\/p>\n

B Denis (1); M Fabre (2); J Bottlaender (1); I Kleinclaus (3); P Straub (3);
\n(1) M\u00e9decine A, H\u00f4pital Pasteur, Colmar; (2) Anatomie et Cytologie Pathologiques, Chu de Bic\u00eatre, Le Kremlin-Bic\u00eatre; (3) Anatomie et Cytologie Pathologiques, H\u00f4pital Pasteur, Colmar;<\/em><\/p>\n

Endoscopie <\/strong>– \u00a02005-06-23 –\u00a0CO –<\/p>\n

________________________________<\/p>\n

Les performances et l\u2019utilit\u00e9 de la ponction pancr\u00e9atique sous \u00e9choendoscopie (PPEE) n\u2019ont \u00e9t\u00e9 \u00e9valu\u00e9es que par de rares centres experts et\/ou qui incluent des patients dans des essais th\u00e9rapeutiques n\u00e9o-adjuvants.
\nBut : \u00e9valuer les performances et l\u2019utilit\u00e9 de la PPEE en pratique courante.
\nPatients et M\u00e9thodes
\nEtude r\u00e9trospective monocentrique de 106 PPEE r\u00e9alis\u00e9es chez 57 H et 49 F entre janvier 2002 et septembre 2004. 47 cas d\u2019interpr\u00e9tation difficile par le pathologiste (P1) \u00e9taient relus par un pathologiste expert (P2). Le diagnostic final \u00e9tait obtenu par chirurgie (n = 30), biopsie percutan\u00e9e (n = 8) ou suivi moyen de 14 mois pour les l\u00e9sions b\u00e9nignes (n = 28). Le diagnostic cyto\/histologique de la PPEE n\u2019\u00e9tait pas \u00e9quivoque dans 40 cas.
\nR\u00e9sultats
\n51 PPEE \u00e9taient r\u00e9alis\u00e9es en ambulatoire. Une complication \u00e9tait not\u00e9e (douleurs abdominales r\u00e9solutives). Les PPEE concernaient 68 tumeurs solides (TS)(dont 44 ad\u00e9nocarcinomes, 8 tumeurs endocrines et 12 noyaux de pancr\u00e9atite) et 38 tumeurs kystiques (TK)(dont 6 TIPMP, 19 cystad\u00e9nomes s\u00e9reux et 4 mucineux, 2 tumeurs endocrines et 4 pseudo kystes) de 5 \u00e0 70 mm de diam\u00e8tre (moyenne 32 mm). La PPEE ne ramenait pas de mat\u00e9riel analysable dans 7 % des TS, un mat\u00e9riel pauvre dans 29 % et satisfaisant dans 63 % des cas. Les performances de la PPEE (diag = diagnostic cyto\/histologique pr\u00e9cis correct) indiqu\u00e9es en % dans le tableau \u00e9valuent le couple \u00e9choendoscopiste + P1 +\/- P2 +\/- biochimie. La relecture par P2 de 39 TS donnait 11 diagnostics suppl\u00e9mentaires de malignit\u00e9 et 29 diagnostics histologiques corrects avec impact th\u00e9rapeutique dans 5 cas. La PPEE avait un impact th\u00e9rapeutique dans 47 % des TS, conduisant 8 fois \u00e0 une chirurgie, \u00e9vitant 7 fois une chirurgie et guidant 17 fois une chimioth\u00e9rapie. La PPEE ne ramenait pas de liquide dans 5 % des TK ou trop peu pour l\u2019analyse cytologique (16 %) ou biochimique (21 %). Les performances de la PPEE pour le diagnostic de TK chirurgicale (mucineuse ou endocrine) sont en % dans le tableau. Les modalit\u00e9s inad\u00e9quates de ponction et de pr\u00e9paration du pr\u00e9l\u00e8vement ne permettaient un diagnostic cyto\/histologique pr\u00e9cis que pour 31 % des TK. La PPEE avait un impact th\u00e9rapeutique dans 40 % des TK, conduisant une fois \u00e0 une chirurgie et \u00e9vitant 14 fois une chirurgie.
\n\t\t Sens\tSp\u00e9\tVPP\tVPN\tDiag
\nDiagnostic de malignit\u00e9 de TS\tP1 (n=60)\t72\t92\t97\t50\t38
\n\t P2 (n=32)\t89\t100\t100\t71\t85
\n\t PPEE (n=68)\t84\t100\t100\t71\t71
\nDiagnostic de TK chirurgicale \tP1+P2 (n=32)\t64\t100\t100\t80\t31
\n\t Bioch (n=30)\t11\t100\t100\t95\t67
\n\t PPEE (n=38)\t58\t100\t100\t95\t66
\nConclusion
\nDans la vraie vie, la PPEE est une technique endoscopique facile et s\u00fbre, r\u00e9alisable en ambulatoire. Toute la difficult\u00e9 r\u00e9side dans l\u2019analyse cyto-pathologique, mais l\u2019envoi par courrier des cas difficiles \u00e0 un pathologiste expert permet d\u2019am\u00e9liorer significativement les performances diagnostiques. A cette condition la PPEE a un impact th\u00e9rapeutique en pratique quotidienne pr\u00e8s d\u2019une fois sur deux pour les TS et les TK. Toutes les structures qui pratiquent de l\u2019\u00e9choendoscopie devraient \u00eatre \u00e9quip\u00e9es pour pouvoir r\u00e9aliser une ponction si n\u00e9cessaire au cours d\u2019une seule proc\u00e9dure.<\/p>\n","protected":false},"excerpt":{"rendered":"

2005 B Denis (1); M Fabre (2); J Bottlaender (1); I Kleinclaus (3); P Straub (3); (1) M\u00e9decine A, H\u00f4pital Pasteur, Colmar; (2) Anatomie et Cytologie Pathologiques, Chu de Bic\u00eatre, Le Kremlin-Bic\u00eatre; (3) Anatomie et Cytologie Pathologiques, H\u00f4pital Pasteur, Colmar; Endoscopie – \u00a02005-06-23 –\u00a0CO – ________________________________ Les performances et l\u2019utilit\u00e9 de la ponction pancr\u00e9atique sous […]<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[6],"tags":[16],"class_list":["post-1796","post","type-post","status-publish","format-standard","hentry","category-endoscopie","tag-16"],"yoast_head":"\nPonction pancr\u00e9atique sous \u00e9choendoscopie : r\u00e9sultats et utilit\u00e9 dans la vraie vie - 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